Lenalidomide Could Minimize an Engraftment Syndrome after Autologous Hematopoietic Stem Cell Transplantation in Patients with POEMS Syndrome

High dose chemotherapy followed by autologous stem cell transplantation (ASCT) is effective therapy for patients with POEMS syndrome. However, treatment before ASCT has not been standardized. In addition, patients are at high risk for an engraftment syndrome (ES) after ASCT, which is associated with morbidity. Lenalidomide has recently emerged as therapeutic options in patients with POEMS syndrome. The purpose of the present study is to evaluate the role of lenalidomide before ASCT. Between December 2005 and May 2011, 7 patients (pts) with POEMS syndrome underwent ASCT at our institution (median age at ASCT: 54 years, range: 36-66). Peripheral blood stem cell (PBSC) was collected using cyclophosphamide (CY) and granulocyte colony-stimulating factor (G-CSF). PBSC was used in 6 pts, whereas bone marrow and PBSC were used in a patient. Patients were conditioned using melphalan (L-PAM; 200mg/sqm: n=5, 140mg/sqm: n=1, 100 mg/sqm: n=1). Of 7 pts, 5 have achieved neurologic improvement after ASCT and are alive with a median follow-up of 44 months (range, 20-81 months), whereas 2 were not evaluated for response because of early death. Interestingly, 2 pts who had received prior therapy, lenalidomide (Case6: 15-20mg per day for 53days, Case7: 15mg per day for 15days), have been alive without ES after ASCT. However, of 5 pts who had not received lenalidomide, 4 pts had ES after ASCT and consequently 2 pts died (5 and 7 months). Lenalidomide has the advantage of being associated with a much lower risk of peripheral neuropathy than new agents such as bortezomib and thalidomide. In addition, lenalidomide could result in successful ASCT without severe ES through possible immunomodulating effects before ASCT.Tabled 1CaseAgeSexMobilization regimenPrior therapyESResponse after ASCTObservation period (months)Outcome136FCY+ G–CSF–NoYes82Alive249FCY+ G–CSF–YesYes81Alive345FCY+ G–CSFDexYesYes45Alive463MCY+ G–CSF–YesNo6Dead552MCY+ G–CSFL–PAM+PSLYesNo7Dead666FCY+ G–CSFLenNoYes25Alive754MCY+ G–CSFLen+DexNoYes20AlivePSL: Prednisolone Dex: Dexamethasone Open table in a new tab